Case Study Analysis – Influenza Pandemic Planning at LHSC

Table of Contents

Executive Summary

I.          Introduction

II.          Problem Statements

III.        Problem Analysis

IV.        Identification and Evaluation of Alternatives

V.         Recommended Course of Action

VI.        Implementation Plan

VII.      Conclusion

Executive Summary

In the given case, there is a rising concern throughout the world due to avian influenza broken out in Southern Asia. This is identified as a risk right now, as the virus is not easily transmittable between humans; plus, it hasn’t reached Canada yet. However, if it mutates, and reaches to Canada, it can quickly spread among the population and easily escalate from a ‘’risk’’ to a ‘’crisis’’.

Cathy Stark, the manager of the Occupational Health and Safety Services Department (OHSS) of the London Health Sciences Centre (LHSC), and the pandemic planning team of the LHSC are provided with an Influenza Pandemic Plan to review, discuss and finalise.

The task is considered risk management for now as the threat is potential, and may or may not occur (Carrol & Brown & Buchholtz, 2018). However, they also take into account that if the risk becomes reality, they’ll find themselves in crisis management, as the estimated impact of the virus is highly significant for the country. On the other hand, as far as the LHSC is concerned, the hospital has 11,000 employees. If Cathy, OHSS, and the planning team fail in risk, and later on, possible crisis management, the virus could break out within the hospital without batting an eye, and cause severe damages in health and safety of the employees.

Cathy is in limbo between her different hats and responsibilities. Her position as a manager of OHSS department requires her to give the employees’ health and safety priority, however as all of them are healthcare workers, they are bound to consider first the patients’ well-being. Besides, in the case of a pandemic, entire hospital staff will be exposed to high risk and danger when taking care of infectious patients. That’s in the nature of being a healthcare worker, and working in a hospital. It’ll be difficult for Cathy and the pandemic planning team to create a fair balance between the safety of employees, and the best possible care of patients.

The Influenza Pandemic Plan includes certain protocols to be imposed on the employees that may raise ethical concerns, or may violate the personal privacy rights of employees. It’s known that community acceptance is crucial in the event of emergency response, so communicating the plan with the hospital staff should be done diligently. If the staff doesn’t understand the rationale behind the protocols, they won’t embrace, and so won’t follow them. This adds another challenge to the planning team’s pile of problems to tackle before a possible outbreak reaches to Canada.  

This paper aims to analyse the case by identifying the issues, opportunities and challenges faced by Cathy Stark, the pandemic planning team, and the LHSC. This report also includes our SWOT analysis for the team getting ready for a possible pandemic situation, and Fishbone analyses for each problem we identified in the case. Further, alternative options that can be implemented have been introduced, and all alternatives have been evaluated by identifying the advantages and disadvantages of each. Then we have provided a recommended course of action and implementation plan for Cathy and the pandemic planning team to follow for the sake of successful risk management.

We highlight that the team needs to consider the plan from different angles and plan for various scenarios. From an ethical perspective, the protocols that may sound sensitive to employees should be well-communicated. Necessary equipment, technology, medical supplies, as well as the protocols should be put in place for both employees and patients in order to maintain the fine balance between the safety of employees and well-being of patients.

If Cathy and the team take the risk management seriously and finalise well-established planning, they can feel hopeful to manage a possible crisis too in case a pandemic breaks out in Canada.

I.         Introduction

London Health Sciences Centre is the first public hospital founded in London, Ontario, Canada in 1875. Employing 11,000 employees now, it’s Canada’s one of the largest hospitals in acute-care teaching in 2007.

1. Cathy Stark is the manager of the Occupational Health and Safety Services Department at LHSC. She has a Bachelor of Science degree in health studies, and her past experiences include working as a health and safety expert in several places before she assigned to her current role at LHSC in 2006. She is also part of the pandemic planning team of the hospital based on her title as the manager of OHSS.
2. OHSS’s responsibilities include the securement of the health and safety of LHSC’s all 11,000 employees, as well as infection control, pandemic planning, communicable disease management, occupational hygiene.
3. Recently, a type of influenza virus which spreads among birds in Southeast Asia raised concerns throughout the world. It’s not easily transmittable to humans, but if it does transmit, it’s likely to cause the death of a patient as it’s highly lethal. It is expected that if this so-called ‘’bird virus’’, or formally called ‘’H5N1’’, starts being transmitted between humans, it reaches to Canada within three months as the world is more connected than before with air travels.
4. In August 2007, Cathy Stark had a meeting with LHSC’s pandemic planning team about the hospital’s proposed Pandemic Influenza Plan. They discussed numerous challenging points that need to be considered in case an influenza pandemic breaks out in Canada. There are ethical concerns, protective measurements, and communication planning that need to be discussed and finalized in order to be pre-prepared for a potential outbreak.   
5. In the case of a pandemic, hospitals’ capacity will be challenged, and excellence in patient care for LHSC will be no longer possible. Additionally, an overloaded hospital will be a burden over the hospital personnel too as not only will they need to work more than usual, they will also be under high risk to get infected, or even die as happened in SARS outbreak in 2003, due to high exposure to viral environments.
6. The impact of this type of virus in Canada is expected to be high with estimations of 4.5 million to 10.6 million people getting sick (this number is for the ones that’ll be clinically tested ill, overall the infection is expected to reach up to 70 percent of the population). Among those, 34,000 to 138,000 people would get hospitalized, 11,000 to 58,000 people would die. 10.6 million people correspond to around one-third of Canada’s (then) population.
7. Influenza vaccine is available at no cost to all Ontario residents, and Canada has a contract signed with GlaxoSmithKline, a worldwide-known vaccine provider company, for a vaccine to be supplied for the entire population Canada. However, the main challenge in this arrangement is that vaccine development may take up to six months, but Canada won’t have six months to wait for one as the virus would have reached and spread in Canada by then. 
8. Economic consequences in the country would be extreme too as the markets, shops, and all social places get closed to stop the spread of the virus. Employees get sick, absenteeism rate increases, productivity decreases, demand goes down, supply falls accordingly, this leads companies to lay off employees or even shut down businesses. Consequently, the unemployment rate soars up, and the entire country finds itself in a dead-end situation.
9. Considering the estimated massive impact on the healthcare sector and the economy of the country, Canada wants to plan ahead in the federal and provincial level to be ready and somewhat prepared for a potential pandemic. LHSC already circulated information among its employees through its internal platform and plans to post some information publicly available on its website.
10. Detailed and diligent planning needs to be done by the pandemic planning team of LHSC as in the event of a pandemic, hospitals will be the primary places that will assume the burden, and the doctors and nurses will be the frontline workers in a war against the virus. Pandemic planning requires a thorough and diligent preparation as the human lives are at stake.
11. Cathy believes that there are many matters of concern, especially the ethical steps that need to be taken. She is in limbo due to her different hats as while LHSC’s aim will be to save public’s lives’, her department’s aim will be to save the hospital employees’ lives; and in the case of a pandemic, it’s likely to be very difficult to maintain both at the same time, up to the best level.
12. The Canadian Medical Association’s (CMA) Code of Ethics, as well as the Canadian Nurses Association’s Code of Ethics for Registered Nurses, mandate that the healthcare practitioners have a responsibility to put the well-being of patients ahead of their own well-being. However, neither of these codes have clear provisions regarding the level of risk the workers should assume on a personal level against their own health and safety when dealing with infectious patients during a pandemic.
13. On the other hand, the Ontario Health and Safety Act (OHSA) regulates that employers should take precautions for the safety of employees, however, there is no clear provision regulating employer’s exact duties and responsibilities against the employees during a pandemic either.
14. While the lack of regulatory provisions doesn’t help Cathy and the rest of the pandemic planning team, there are also internal issues they need to consider such as how to communicate the plans and framework with the employees, or how to make sure that the employees will behave in an ethical manner in the event of a possible health crisis.
15. There will be stringent measures to be imposed on employees, some of which may raise a concern or cause inconvenience among the staff, especially regarding their personal liberty rights. Cathy knows that she needs a good communication plan to convey the protocols in the best way possible, because if the staff resists or don’t adopt the protocols, that may cause an additional crisis in the hospital as if a pandemic to deal with is not enough.

II.      Problem Statements

The following issues need to be addressed:

Problem 1: An overall detailed and diligent planning needs to be done by the pandemic planning team as in the event of a pandemic, hospitals will be the primary places that will bear the burden, and the doctors and nurses will be the frontline workers in a fight against the virus.

LHSC is already working close to full capacity. In the case of a pandemic, the hospital will be overloaded, the staff’s ability to deliver the best possible care to patients will be challenged. The staff will need to do overtime, some may start feeling burnout and even experience psychological disorders due to high risk and stress. The plan to be finalized by Cathy and the planning team will need to cover different scenarios that may occur during a pandemic, and will need to specify how to act or react in such circumstances.

Problem 2: As healthcare workers, hospital staff’s responsibility is to give priority to patients’ health, whereas as a manager of OHSS’ department, Cathy’s responsibility is to ensure the health and safety of the hospital employees. These two responsibilities can create conflict in the event of a pandemic.

LHSC is required to take every precaution to maintain the safety of its employees as per the OHSA. Cathy is responsible for fulfilling this requirement as a manager of OHSS department. However, in the event of a pandemic, hospital staff will face life-threatening risk every day when dealing with infectious patients under an overtaxed hospital conditions as they are supposed to, according to the medical acts they are bound up with. Cathy and the team need to clarify how they are supposed to respond if a conflict occurs between the responsibilities of different roles.

Problem 3: A strong communication plan is needed for the proper conveyance of the emergency response protocols to the hospital employees. Employees’ acceptance and adaptation is crucial; if they don’t embrace the new rules, they won’t adhere to them.

There will be drastic measures to be imposed on employees to maintain the health and safety of them as well as the patients. These precautions may seem extra or make some feel uncomfortable. Cathy and the team need to engage with the hospital staff deeply as they know that community acceptance is crucial in emergency management. They need to be coordinated and coherent in all stages from setting new procedures, announcing new protocols, to communicating those with the staff, and making sure everyone adheres to them.

Problem 4: Pandemic planning may include some procedures to be imposed on employees contradictory to personal liberty and privacy rights.

The planning team needs to know to what extent personal and privacy rights of healthcare workers can be infringed during a pandemic to save the public’s lives. Relevant regulations should be reviewed, and necessary discussions should be made by the team to determine how much infringement is legally allowed and will be fair under various circumstances.

Problem 5:  Cathy and the planning team need to make sure that the hospital employees behave ethical during the pandemic.

In SARS outbreak in 2003, there were cases where workers called in sick even though they weren’t, some didn’t take anti-viral medications provided primarily to them to bring them to their family, some refused to come to work due to high exposure risk, and so on. The planning team wants to manage the sensitive situations correctly, and appropriately communicate with the staff for them to comprehend their ethical responsibilities and behave ethically during peak times.

Problem 6: Neither CMA nor the Canadian Nurses Association has clear provisions regarding how much health and safety risk that healthcare personnel should assume on a personal level when dealing with infectious patients in the event of a pandemic.

Both regulations state that the practitioners should put patients’ well-being beyond their own well-being; however, in case of a real-life situation, the limits of the personal risk that healthcare workers should undertake are not clear. Should they run the risk of getting sick by a deadly virus, or even death when trying to save patients?

Problem 7: No regulation clearly specifies the employer’s duties against the employees to protect their safety and health during an emergency response.

The OHSA stipulates that employers are required to take every precaution to ensure the workers’ safety. However, this is a general and generic provision as the OHSA is a general act for all employers acting under normal conditions. Cathy and the planning team would enjoy a more specific regulation that provides certain duties of employers against the employees to be fulfilled under emergency conditions such as a pandemic. 

Problem 8:  LHSC employees include workers other than doctors and nurses and there is no regulation applicable to those as to their ethical or professional responsibilities during a pandemic.

LHSC staff doesn’t consist of doctors and nurses only, but support staff, hospital admin staff, cleaning staff, etc. too. All will be on the same board when it comes to the fight against the pandemic, but there is no clarity for the non-medical staff’s duties and responsibilities under the law. Are they bound up with the codes of medical associations as in the case for doctors and nurses? Are the existing provisions for the healthcare workers applicable to them?

Problem 9: If Cathy and the rest of the pandemic planning team do a bad job to employ safety arrangements in place, certain employees may refuse to work as permitted under the OHSA.

OHSA allows first responders to refuse to come to work in case they feel unsafe at the workplace. As every worker will be essential in the case of a pandemic, LHSC won’t be able to afford any of its doctors, nurses or other hospital workers to apply to this provision and be waived off work due to safety concerns. Therefore, Cathy and the pandemic planning team needs to put the proactive measurements in place for the workers to safely show up.

Problem 10: LHSC is known for its dedication to excellence in patient care. If the hospital loses control over the staff or the patients in the pandemic, as so hampers the quality of patient care of the hospital, LHSC’s reputation will be damaged.

LHSC is one of the largest acute-care teaching hospitals in Canada and it has a mission of service excellence to patients. If the hospital fails to manage the pandemic well and have a high death rate comparing to other hospitals, LHSC’s reputation will get a hard hit.

Problem 11: If any doctors or nurses of LHSC get sick or die as happened in the SARS outbreak in Canada, this creates a highly devastating impact on the entire hospital team. The planning team needs to do its best in management in order not to be seen responsible for such events in the course of the pandemic.

If the management fails to keep the health and safety protocols in place and it ends up with an outbreak among the hospital staff, then the staff may blame the pandemic planning team or even Cathy for their loss. Therefore, Cathy and her team need to make sure to put in place the best measures in order not to be accused of any unfavorable incidents afterwards.

III.   Problem Analysis

SWOT Analysis for the LHSC Pandemic Planning Team including Cathy Stark

Strengths	Weaknesses	Opportunities	Threats
Cathy Stark is a seasoned professional in the healthcare sector with a Bachelor of Science in health studies degree, and vast work experience in health and safety positions.	The lack of regulation regarding the level of risk the healthcare workers should assume on a personal level during a pandemic, causes unease for Cathy and the pandemic planning team.	If Cathy and the pandemic planning team does a good job in emergency management as well as saving the patients’ lives during the pandemic, this will add to LHSC’s good reputation.	The biggest threat is, now the situation is identified as a risk however if the virus becomes transmittable to humans and it reaches to Canada, then the situation can quickly turn into a crisis.
Based on their experience with SARS outbreak in 2003, the team has many useful insights into the several circumstances that may be expected to occur during the pandemic, so that they can discuss and pre-planned for them.	The lack of legislation as to the employer’s duties and tasks against the employees under pandemic circumstances creates ambiguity and unease for Cathy and the team.	If Cathy and the pandemic planning team achieve to provide a sense of security for the employees, that can boost their morale, and lower the absenteeism. Those who feel safe and secure serve better to patients too.	If proper communication planning doesn’t take place, conflicts and/or complaints may occur among the staff members due to lack of understanding or appreciation of the new protocols.
LHSC has already created a Pandemic Influenza Plan draft, and the pandemic planning team has already published information helpful for pandemic planning on the hospital’s internal platform for the staff. All this is before the virus reaches to Canada, which gives an early mover advantage to the team.	There is no specific legislation applicable to the hospital staff other than the doctors and nurses. The lack of such legislations leaves their pandemic duties and responsibilities unclear.	It’s been about 1 year since Cathy started in LHSC. If she succeeds to manage the pandemic response well within the LHSC, that’ll bring good personal reputation to her, and possibly allow her to secure position for many years too.	A moment of distraction for any worker, or safety measures neglected by the pandemic planning team can cause an outbreak among the hospital staff.
LHSC is specialised in acute-care, and it’s one of the largest hospitals in its field in Canada. Since this virus will cause acute situations on humans, LHSC’s doctors will be at least familiar with how to deal with urgent medical conditions.	If not communicated well, the disciplinary actions and protocols to be imposed by the pandemic protocols may create a sense of panic and disobedience among the employees.	If the LHSC and the team manage the risk well now, that will raise hope that they will manage a possible crisis well too if a possible pandemic breaks out in Canada.	As happened in the SARS outbreak, doctors, nurses or other hospital staff may get sick, and even lose their lives.
	Pandemic planning may include some procedures contradictory to personal liberty and privacy rights of employees.	A strong and effective emergency management plan strengthens an organization in the long run.	Hospital staff will face life-threatening risk every day when working in the hospital during the pandemic.
	It’s expected that the virus reaches to Canada in 3 months. 3 months may not be sufficient for the team to develop a detailed and diligent pandemic management plan.		The staff may experience burnout, anxiety, depression, trauma, and psychological issues due to high stress and exposure risk that posed to them.
	Cathy and OHSS struggle with an ethical dilemma. The manager’s and department’s main responsibility to ensure the safety of the hospital employees. However, the pandemic will pose a great level of danger to employees’ safety, and they are legally bound to deal with it.		If the pandemic planning fails to provide a sense of security to employees, they may refuse to show up at work as per the OHSA, if they feel the working conditions aren’t safe, or pretend to be falsely sick to avoid the danger.
	The hospital is already working full capacity, and in case of a pandemic, they are likely to face with a capacity problem.

IV.   Identification and Evaluation of Alternatives

Identification of Alternatives:

1. Cathy and the pandemic planning team starts with researches in databases to collect all relevant information that could provide insights into what happened in the previous pandemics in human history. Reading and learning from past events allow them not to make the same mistakes again.
2. All relevant legislation and regulatory documents are reviewed by the team to gather provisions and regulations that are applied to pandemic circumstances, and employers’ and employees’ duties and responsibilities during a pandemic.
3. This new virus is known to hit the lungs in humans. The team expects that oxygen machines and air ventilators will be needed to treat patients who suffer from difficulty in breathing. Therefore, the hospital makes sure that they have all the necessary equipment, as well as the technology and infrastructure, to save patients’ lives.
4. Cathy’s department OHSS’ main responsibility is to secure the health and safety of the employees. Therefore, personal protective equipment (PPE) for all hospital staff are ordered in bulk to make sure the staff will never be lacking in essential equipment during the pandemic.
5. All medical supplies, PPE, and anti-viral medications are stored in a safe place under lock and key for the entire pandemic term in order to avoid loss or theft.
6. Training is provided to all hospital staff according to their positions and knowledge levels. Training includes essential information such as the characteristics of the virus, how to use PPE properly, how to treat infectious patients, what to do to maintain personal hygiene and safety while working, and so on.
7. Regardless of how good the plan is, if it’s not communicated well with the employees, it won’t be embraced and so not implemented by them. Therefore, Cathy and the planning team put a significant effort into creating a well-established communication plan.  
8. In particular, the rationale behind the certain protocols that may be considered infringing personal liberty or privacy rights is explained thoroughly to the employees in order to avoid any conflict or resistance among them. 
9. In addition to the protocols regarding concrete, tangible steps to follow, ethical behaviours that should be adopted by the employees are also defined in the planning process to make sure the hospital staff will not only perform their profession well, but also keep acting ethically in the course of the pandemic. 
10. Disciplinary procedures are put in place to avoid absenteeism, as well as unethical acts, among the employees.
11. In order to keep the employees motivated, the protocols include rewards therein such as: ‘’If there’s no hospital staff gets sick in the first 14 days, all staff will see a bonus in their bi-weekly paycheque’’. This and similar kind of rewards encourage the staff to comply with the protocols, and act diligently.
12. The team makes sure that the hospital’s intranet is always kept up-to-date, and the staff is able to find any information and update easily and quickly there.
13. Possibility of burnout, anxiety, trauma or depression to be experienced by the staff is addressed in the planning too as it’s expected that the high stress and pressure will cause psychological problems for the staff. 
14. Emergency response requires acting fast. So overall, Cathy and the team creates a plan where acting proactive rather than reactive, and being preventive more than treater, are appreciated. The virus always gets them if they don’t decide or move quickly during the process.

Evaluation of Alternatives:

Alternative 1: Cathy and the pandemic planning team starts with research in databases to collect all relevant information that could provide insights into what happened in the previous pandemics in close history.

Advantages:

1. Reading and learning from past events allow them not to make the same mistakes again. 
2. Decisions would be more effective and reliable as the learnings from the precedents are reflected.

Disadvantages:

1. The team may have a limited time, and this research process will take some time before they initiate the planning.
2. Past readings and learning is not certain to be sufficient for future planning as the future is uncertain, and the next pandemic may cause rather different situations.

Alternative 2: All relevant legislation and regulatory documents are reviewed by the team to gather provisions and regulations that are applied to pandemic circumstances, and employers’ and employees’ duties and responsibilities during a pandemic.

Advantages:

1. The team and the LHSC will save themselves from any possible legal actions or proceedings that may be initiated by the staff due to violation of any regulation during the process.
2. Referring to legal regulations and obligations will allow the team’s actions and rules look justified.
3. Employee acceptance will be maintained easier and quicker when the protocols are based on legal obligations.

Disadvantages:

1. The team may have a limited time, and this research process will take some time before they initiate the planning.
2. Legislation check may not bring any result to the team as even most of the relevant codes and acts already checked by the team doesn’t say much about the responsibilities during a pandemic.

Alternative 3: This new virus is known to hit the lungs in humans. The team expects that oxygen machines and air ventilators will be needed to treat patients who suffer from difficulty in breathing. Therefore, the hospital makes sure that they have all the necessary equipment, as well as the technology and infrastructure, to save patients’ lives. 

Advantages:

1. Advanced planning will help the hospital to be prepared for a possible health crisis that requires certain equipment to save patients’ lives.
2. With the advancement in technology and infrastructure, the hospital can have a high recovery rate, which allows them to treat patients quicker and avoid extreme overload of the capacity.

Disadvantages:

1. Improvement in technology, infrastructure and purchase of new equipment may be costly for the hospital.  
2. They may be never used if the virus doesn’t arrive in Canada.

Alternative 4: Cathy’s department OHSS’ main responsibility is to secure the health and safety of the employees. Therefore, personal protective equipment for all hospital staff is ordered in bulk to make sure the staff will never be lacking in essential equipment during the pandemic.

Advantages:

1. Sense of security and a safe environment will encourage the employees to perform well and focus on their work rather than safety issues.
2. Advanced planning will help the hospital to be prepared for a possible health crisis that requires certain equipment to ensure the workers’ safety.
3. Having enough equipment for personal safety will reduce the stress in employees and prevent them from getting sick while treating infectious patients.

Disadvantages:

1. There will be a cost effect of such investment in equipment which may never be required if the virus doesn’t reach to Canada.   
2. Mental health / psychology issues may still arise in employees. PPE can protect them physically not mentally.

Alternative 5: All medical supplies, personal protective equipment, and antiviral medications are stored in a safe place under lock and key for the entire pandemic term.

Advantages:

1. This will help the hospital prevent critical medical supplies from loss or theft.

Disadvantages:

1. LHSC may need to hire armed forces to protect such equipment and supplies which will be another cost item for the hospital.

Alternate 6: Training is provided to all hospital staff according to their positions and knowledge levels. Training includes essential information such as the characteristics of the virus, how to use PPE properly, how to treat infectious patients, what to do to maintain personal hygiene and safety while working, and so on. 

Advantages:

1. Training will educate the entire staff, build confidence in them, improve their morale, and minimise the mistakes in services.
2. Proper training can prevent many issues to occur, and help the hospital staff to manage the possible health crisis well.

Disadvantages:

1. During their daily hectic schedule, training may sound cumbersome for the hospital staff.
2. Training may turn out to be unnecessary eventually if the virus doesn’t reach to Canada.

Alternative 7: Regardless of how good the plan is, if it’s not communicated well with the employees, it won’t be embraced and so not implemented by them. Therefore, Cathy and the planning team put a significant effort into creating a well-established communication plan.  

Advantages:

1. If Cathy and the team engage with the employees well, then having them comply with the protocols will be easy.  
2. Good and frequent communication with the employees reduces the conflicts that may arise, allow employees to feel comfortable to share suggestions and/or concerns with the team, and so help the team in their decision-making.

Disadvantages:

1. Regardless of how much effort is put in the communication, there will be always some who’re not satisfied, because it’s impossible to please everyone.
2. Regardless of how good the communication plan is, each staff member will have a different level of understanding and perception on which Cathy or the team cannot control.

Alternatives 8: In particular, the rationale behind the certain protocols that may be considered infringing personal liberty or privacy rights are explained thoroughly to the employees in order to avoid any conflict or resistance among them.  

Advantages:

1. If the employees understand the rationale behind the rules, they are more likely to adhere to them.
2. Understanding the rationale behind the rules will mitigate the risk of conflict or concerns that may be raised by the employees.

Disadvantages:

1. If Cathy or the planning team fails to do this, they may even face a legal proceeding initiated by the employees who think the hospital infringed their privacy rights.

Alternative 9: In addition to the protocols regarding concrete, tangible steps to follow, ethical behaviours that should be adopted by the employees are also defined in the planning process to make sure that the hospital staff will not only perform their profession well, but also keep acting ethically in the course of the pandemic.  

Advantages:

1. Pandemic planning and emergency response require not only professional rules, but also ethical and moral standards too. Defining those will clarify the issues for the employees.

Disadvantages:

1. Every individual has a different level and understanding when it comes to ethical and moral requirements.  Therefore, it is likely to be one of the most difficult protocols for Cathy and the planning team to communicate with the employees.

Alternative 10: Disciplinary procedures are put in place to avoid absenteeism, as well as unethical acts, among the employees. 

Advantages:

1. Avoiding absenteeism will help LHSC to better deal with the overtaxed hospital situation.
2. Disciplinary procedures will be likely to force employees to stay ethical, and show up at work.

Disadvantages:

1. It’s crucial for the team to arrange the severity of the disciplinary actions, because if the employees find them extreme; then concerns, conflicts, and resistance to following the rules may occur.

Alternative 11: In order to keep the employees motivated, the protocols include rewards therein such as: “If there’s no hospital staff getting sick in the first 14 days, all staff will see a bonus in their bi-weekly paycheque’’. This and similar kinds of rewards encourage the staff to comply with the protocols, and act diligently. 

Advantages:

1. Providing financial incentives based on their success to keep themselves safe will be a win-win situation for all parties. Cathy and the team will maintain the safety of the employees as they are required, and the employees will be more careful and do their best not to get sick to receive the rewards.
2. There will be less absenteeism.

Disadvantages:

1. It may be challenging for the hospital’s budget and can be very costly to provide a bonus to all employees while dealing with the costly pandemic. 

Alternative 12: The team makes sure that the hospital’s intranet is always kept up-to-date, and the staff is able to find any information and update easily and quickly there.

Advantages:

1. Easy and quick access to information and updates will help employees to perform better and keep on track.
2. There will be no delay in any work/action due to lack of information or update.

Disadvantages:

1. Since every resource will be essential during a possible pandemic, this is not easy to maintain as the team needs to dedicate some resources to deal with updating the intranet frequently every day.

Alternative 13: Possibility of burnout, anxiety, trauma or depression to be experienced by the staff is addressed in the planning too as it’s expected that the high stress and pressure will cause psychological problems for the staff. 

Advantages:

1. Addressing these issues will hopefully reduce the occurrence pf the stress-related problems for the staff and decrease their anxiety.

Disadvantages:

1. The team may need to enforce counselling or therapy sessions for the staff who work under the high risk, pressure or stress. This will be another cost item for the hospital.

Alternative 14: Emergency response requires acting fast. So overall, Cathy and the team creates a plan where acting proactive rather than reactive, and being preventive more than treater, are appreciated. The virus always gets them if they don’t decide or move quickly during the process.

Advantages:

1. Immediate action will allow them to have control over possible situations. 

Disadvantages:

1. Working and acting fast is likely to lead to more mistakes.
2. During a pandemic, some decisions may need proper care and discussion which needs time. Therefore, it might be difficult for the team to act fast, and also make the best decision.

V.      Recommended Course of Action

The following course of action should be implemented to address the problems:

1. The pandemic planning team starts with researches in databases to collect all relevant information that could provide insights into what happened in the previous pandemics in human history.
2. All relevant legislation and regulatory documents are reviewed by the team to gather provisions and regulations that are applied to pandemic circumstances, and employers’ and employees’ duties and responsibilities during a pandemic.
3. When the team collects all necessary information, they identify all issues to be discussed, create a roadmap, and a pandemic planning framework.
4. Pandemic planning will include necessary training and psychological care for the employees, well-established communication plan, disciplinary procedures, and ethical requirements that will need to be fulfilled by the hospital staff.
5. In addition, the management announces monetary or non-monetary incentives to the employees to increase their morale and dedication towards work. This will also decrease the absenteeism among them.
6. In order to be in frequent communication with the employees, the team holds regular meetings where employees can participate. That way, employees will be able to share their opinions and suggestions directly to the team, and the team gets to know the concerns of employees, and adjust their decisions accordingly. 

7. The team makes sure that the hospital has all the necessary equipment, as well as the technology and infrastructure, to save patients’ lives.
8. Personal protective equipment for all hospital staff is ordered in bulk to make sure the staff will never be lacking in essential equipment during the pandemic.
9. Necessary medical supplies and anti-viral medications are ordered in bulk to make sure that the medical workers have everything they need to deliver the best possible treatment to the patients throughout the pandemic.
10. All medical supplies, PPE, and anti-viral medications are stored in a safe place under lock and key for the entire pandemic term in order to avoid loss or theft.
11. If the current number of doctors and nurses are not sufficient to handle a possible overload in the hospital’s capacity, then the Human Resources department of the hospital is informed, and new hirings are arranged.
12. The team makes sure that the hospital’s intranet is always kept up-to-date, and the staff is able to find any information easily and quickly there. A section in the intranet is made available for employees to ask questions regarding the protocols or any other emergency response arrangements to the management. This will reduce mistakes and misunderstandings. 
13. Frequent inspections are conducted by the team within the hospital to make sure that the pandemic protocols are followed, and the health and safety standards are met.

VI.   Implementation Plan

Immediate Actions:

1. The pandemic planning team conducts researches in databases to collect all relevant information that could provide insights into what happened in the previous pandemics in human history.
2. All relevant legislation and regulatory documents are reviewed by the team to gather provisions and regulations that are applied to pandemic circumstances, and employers’ and employees’ duties and responsibilities during a pandemic.
3. When the team collects all necessary information, they identify the issues, create a roadmap, and a pandemic planning framework. It includes necessary training and psychological care for the employees, well-established communication plan, disciplinary procedures, and ethical requirements that will need to be fulfilled by the hospital staff.
4. In addition, the management announces monetary or non-monetary incentives to the employees to increase their morale and dedication towards work. This will also decrease the intentional absenteeism among them.
5. The team holds regular meetings where any employees can participate. That way, employees share their opinions and suggestions, and the planning team gets to know the concerns of employees, and make decisions accordingly. 
6. The team makes sure that the hospital has all the necessary equipment, as well as the technology and infrastructure, to save patients’ lives.
7. Personal protective equipment for all hospital staff is ordered in bulk to make sure the staff will never be lacking in essential equipment during the pandemic.
8. Necessary medical supplies and anti-viral medications are ordered in bulk to make sure that the medical workers have everything they need to deliver the best possible treatment to the patients throughout the pandemic.
9. All medical supplies, PPE, and anti-viral medications are stored in a safe place under lock and key for the entire pandemic term in order to avoid loss or theft.
10. If the current number of doctors and nurses is not sufficient to handle a possible overload in the hospital’s capacity, then the Human Resources department of the hospital is informed, and new hirings are arranged. This will also allow the team to make sure there is enough labour force in case of intentional absenteeism of employees.
11. The team makes sure that the hospital’s intranet is always kept up-to-date, and the staff is able to find any information easily and quickly there. A section in the intranet is made available for employees to ask questions regarding the protocols or any other emergency response arrangements to the management. This will reduce mistakes and misunderstandings. 
12. Frequent inspections are conducted by the team within the hospital to make sure that the pandemic protocols are followed, and the health and safety standards are met.
13. Any healthcare staff who show the symptoms is tested immediately, and if found positive, provided treatment for free at the LHSC immediately.
14. Shifts are arranged carefully to make sure that none of the hospital workers will undergo a burnout due to extreme long hours of working. 
15. At least one representative from the OHSS department is made available 24/7 for doctors, nurses, or any other hospital staff in case they direct support or instructions regarding the protocols.

Short-term Actions:

1. Frequent inspections are conducted by the team within the hospital to make sure that the pandemic protocols are followed, and the health and safety standards are met.
2. The team keeps holding regular meetings where employees can participate. That way, employees share their opinions and suggestions, and the planning team gets to know the concerns of employees, and make decisions accordingly. 
3. Employees will be offered counselling or therapy sessions (through video or audio call) every week with a psychologist to avoid mental trauma and stress caused by the pandemic response.
4. Employees who falsely call in sick or doesn’t show up at work for no reason will be laid off.

Long-term Actions:

1. Frequent inspections are conducted by the team within the hospital to make sure that the pandemic protocols are followed, and the health and safety standards are met.
2. The team keeps holding regular meetings where employees can participate. That way, employees share their opinions and suggestions, and the planning team gets to know the concerns of employees, and make decisions accordingly. 
3. Employees will be offered counselling or therapy sessions (through video or audio call) every week with a psychologist to avoid mental trauma and stress caused by the pandemic response.
4. Employees who falsely call in sick or doesn’t show up at work for no reason will be laid off.
5. Every lesson learned from this pandemic will be noted by the team for the improvement of the Pandemic Influenza Plan of the LHSC. The learnings from this pandemic will help the staff to plan better for the next ones, if any.
6. Employees worked during the pandemic will be entitled to post-pandemic benefits.

VII.     Conclusion

In summary, Cathy and the planning team roll up their sleeves for an aim to conduct successful risk management. Depending on the mutation probability of the virus, a possible influenza pandemic may arrive in Canada as little as in three months. Cathy and the team need to move quickly, decisively and effectively to ensure the necessary measures are in place before the pandemic hits the country, and the risk transforms into a possible crisis.

Starting with research on the previous pandemics and also the relevant regulations on the case will provide them with a massive insight on what to do, and what not to do. Advanced planning and regular meetings with the staff will allow them to learn from the staff and act accordingly. Stocking the necessary equipment and medical supplies in advance that will be required for employees and patients will make the staff feel safe and secure, and allow them to deliver the best possible care to patients. Effective communication with the employees will be given topmost priority; therefore, Cathy and the team will meet with the employees regularly in close meetings to hear their concerns and suggestions. Ethical requirements and disciplinary actions will be enabled too, and the regular inspections will allow the team to closely monitor and control the outcomes of the pandemic.

This planning carries a conflict in its nature, and causes a dilemma for Cathy; however, if Cathy and her team follow proper planning, they can maintain the fine balance ensuring the safety and well-being of both employees and patients during a possible pandemic.

References

Carroll, A. B., Brown, J. A., Buchholtz, A. K. (2018). Business & Society: Ethics, Sustainability & Stakeholder Management. Boston, US: Cengage Learning.

House, D. (2008). Influenza Pandemic Planning at LHSC. Ivey Publishing.